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Getting Emergency Care

Two middle-aged men, one white and one Latino, are walking on the beach and talking

Alan, 52, was visiting friends when he felt pain in his lower back and abdomen. He called his doctor’s office and was told to head for the nearest ER. “It was the worst pain I’ve ever experienced.”

Read Alan’s story.

In an emergency, you should call 9-1-1 or go to the nearest emergency room (ER).

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What is an emergency?

It is an emergency if you reasonably believe that if you don’t get care right away, it could be dangerous to your life or to a part of your body. Emergencies include active labor, a bad injury, severe pain, and an illness that is suddenly getting much worse.

How to get emergency care

  • If you can, go to the emergency room at a hospital in your health plan’s network.
  • Try to take your membership card with you.
  • If you are not sure if it is an emergency and there is time, call your doctor.
  • If you are admitted to a hospital outside your plan’s network, call the plan within 24 hours, or as soon as you can. Your plan may move you to a hospital in its network, if it is possible without danger to your health.

When can I call an ambulance?

Health plans only pay for an ambulance when:

  • You call 9-1-1 because you think you are having an emergency and cannot get to the hospital safely or quickly enough in a car.
  • Your doctor says you need an ambulance and the health plan pre-approves it.

How to get urgent care

Urgent care is care you need soon, usually within 24 hours, for a problem that is serious but is not an emergency. Examples include earache, a sprain, or a minor burn.

  • Some plans have urgent care clinics you can go to directly. Otherwise, call your primary care doctor and ask what to do.

How to get care when you are away from home

Before you leave home, ask your plan how to get care when you are traveling.

  • Emergency and urgent care are usually covered anywhere in the world.
  • If you have an emergency, call 9-1-1 or go to the nearest ER.
  • If you need urgent care, call your primary care doctor or the health plan if you can. If you cannot, go to the nearest clinic or urgent care center.
  • Take your membership card with you.
  • If you need follow-up care, call your primary care doctor.

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